Though early stage head and neck cancers can be cured either by surgery or radiation, patients with locally advanced disease continues to pose a therapeutic challenge. Locoregional failure is the major cause of death in head and neck cancers. As the outcome of locally advanced head and neck cancer is less than promising, a combined modality approach is generally undertaken in this group of patients. The combination of surgery, radiation and more recently, chemotherapy and targeted therapy can improve outcomes in locally advanced head and neck cancer patients. This overview discusses the rationale and role of postoperative radiotherapy (PORT) in advanced head and neck cancers, the radiotherapy technique in brief and methods of enhancing the efficacy of postoperative RT by altering the fractionation schedules and adding chemotherapy and targeted therapy.
Epidemiology of head and neck cancers. Semin Surg Oncol 1989;5(5):305–09.
Parameters that predict local control after definitive radiotherapy for squamous cell carcinoma of the head and neck. Head Neck Jul 2003;25(7):535–42.
Postoperative radiotherapy in head and neck carcinoma with extracapsular lymph node extension and/or positive resection margins: A comparative study. Int J Radiat Oncol Biol Phys 1992;23(4):737–42.
Combined neck dissection and postoperative radiation therapy in the management of the highrisk neck: A matched-pair analysis. Int J Radiat Oncol Biol Phys Feb 1998 2;40(3):529–34.
Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: Three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet Mar 2000;18;355(9208):949–55.
Recurrent advanced (T3 or T4) head and neck squamous cell carcinoma: Is salvage possible? Arch Otolaryngol Head and Neck Surg Jan 2004;130(1):35–38.
Planned combination of surgery and radiation in treatment of advanced primary head and neck cancers. Am J Roentgenol Radium Ther Nucl Med Mar 1957;77(3):397–414.
Combined radiation therapy and surgery in the management of advanced head and neck cancer: Final report of study 73-03 of the Radiation Therapy Oncology Group. Head and Neck Surg Sep-Oct 1987;10(1):19–30.
Evaluation of the dose for postoperative radiation therapy of head and neck cancer: First report of a prospective randomized trial. Int J Radiat Oncol Biol Phys Apr 1993;30;26(1):3–11.
Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head and neck cancer. Int J Radiat Oncol Biol Phys Nov 2001;1;51(3):571–78.
Precisely defining high-risk operable head and neck tumors based on RTOG #85-03 and #88-24: targets for postoperative radiochemotherapy? Head and Neck Oct 1998;20(7):588–94.
Factors related to regional recurrence in early stage squamous cell carcinoma of the oral tongue. Clin Exp Otorhinolaryngol Sep 2008;1(3):166–70.
Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg Oct 1989;158(4):309–13.
Tumor thickness influences prognosis of T1 and T2 oral cavity cancer—but what thickness? Head and Neck Nov 2003;25(11):937–45.
Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head and Neck May 1997;19(3):205–10.
Postoperative radiotherapy in carcinoma of buccal mucosa, a prospective randomized trial. Eur J Surg Oncol Oct 1996;22(5):502–04.
Postoperative radiotherapy improves survival in squamous cell carcinoma of the hypopharynx. Am J Surg Nov 1994;168(5):476–80.
The influence of the radicality of resection and dose of postoperative radiation therapy on local control and survival in carcinomas of the upper aerodigestive tract. Int J Radiat Oncol Biol Phys 2000 Jul 15;47(5):1287–97.
Supraglottic laryngectomy for intermediate-stage cancer: UTMD. Anderson Cancer Center experience with combined therapy. Laryngoscope Aug 1990;100(8):831–36.
Postoperative IMRT in head and neck cancer. Radiat Oncol 2006;1:40.
The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988;27(2):131–46.
Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: Influence of proliferation. Br J Cancer Feb 2002;12;86(4):517–23.
Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer. Radiother Oncol Feb 2004;70(2):183–88.
Does delay in starting treatment affect the outcomes of radiotherapy?A systematic review. J Clin Oncol Feb 2003;1;21(3):555–63.
Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: Report on Intergroup Study 0034. Int J Radiat Oncol Biol Phys 1992;23(4):705–13.
Final report of the Head and Neck Contracts Program. Cancer Aug 1987;1;60(3):301–11.
Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med May 2004;6;350(19):1937–44.
Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med May 2004;6;350(19):1945–52.
Meta-Analyses of Chemotherapy in Head and Neck Cancer (MACH-NC): An update. Int J Radiat Oncol Biol Phys 2007;69(2 Suppl):S112–4.
Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med Feb 2006;9;354(6):567–78.
Efficacy evaluation of the humanized anti-EGFR MAb h-R3 (nimotuzumab) in combination with radiotherapy in the treatment of patients with unresectable squamous cell carcinomas of the head and neck. Eur J Cancer 2006;4:62.
BioMAb EGFRTM (Nimotuzumab/h-R3) in combination with standard of care in squamous cell carcinoma of head and neck. Int J Radiat Oncol Biol Phys 2007;69(1):S450.